Provider Demographics
NPI:1881708956
Name:TAMAROFF, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:TAMAROFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3916
Mailing Address - Country:US
Mailing Address - Phone:845-357-2373
Mailing Address - Fax:
Practice Address - Street 1:59 MILE RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3916
Practice Address - Country:US
Practice Address - Phone:845-357-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0427541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02528123Medicaid
NY269681OtherVALUE OPTIONS PROVIDER #
NYJT0N5H0720OtherBCBS PROVIDER #
NY6013297OtherGHI PROVIDER NUMBER
NYS30899Medicare UPIN
NY6013297OtherGHI PROVIDER NUMBER